Quality street

New conditions added to the national clinical audit programme commissioned by the Healthcare Quality Improvement Partnership (HQIP) include prostate cancer, learning disabilities and COPD. HQIP has also made public (rather ahead of schedule) guidance on what makes a good or effective clinical audit. At the somewhat more theoretical level a paper from the RAND Corporation asks How do quality improvement interventions succeed?

Cancer update

Radiotherapy following breast cancer surgery is beneficial, according to a meta analysis published in the Lancet, with recurrence rates over 10 years halved and death rates over 15 years reduced by about a sixth. Analysis of geographical variations in cancer survival in England from the Cancer Network suggests that although the North-South divide has become less marked over time, geographical inequalities nevertheless persist. the study's authors suggest that the trend in breast cancer survival, where geographical inequalities are lessening, may be followed by other cancers in time. The Whitehall II study continues to offer up opportunities for new analysis: amongst which an assessment of risk factors for colorectal cancer. This 40 year follow up finds smoking to be a significant risk.

You say you want a revolution

The NHS information revolution was the focus of a conference hosted by the King's Fund recently. You can catch up with some of the presentations online, via the King's Fund webpages. Highlights include a paper on meeting the information needs of Clinical Commissioning Groups (CCGs) and another on the relationship between information, patients and choice, as well as a keynote address from Sir Muir Gray on what he is pleased to call the third healthcare revolution of knowledge, information and value. Also at the conference Giles Wilmore, Director of Quality Framework and QUIPP Programmes at DH, announced that publication of DH's new information strategy could not be expected before next spring (a second deferral for the unveiling of these plans). The Health Service Ombudsman's rather critical report on complaints handling in the NHS includes a plea for the information revolution to spread to information about complaints.

False positives

The debate over the value of the UK Breast Cancer Screening programme reached a wider audience today, as the media picked up Mike Richards' announcement in the BMJ of an independent review. A recent Cochrane review has suggested that screening for breast cancer "seems likely to reduce breast cancer mortality" but the level of reduction is small. Moreover the extent of disbenefit from unnecessary treatment for misdiagnosed healthy women, along with psychological distress, means that it is "not clear whether screening does more good than harm."

Nothing about me ...

... was well on the way to becoming reality as Andrew Lansley launched the Right Care shared decision making programme. Under the lovely mantra "Right Care, Right Patient, Right Place, Right Time," the thinking behind this policy is driven by the patient empowerment agenda that has run through the government's health reforms. The NHS Right Care site provides an update on the roll-out of the programme and the publication of Patient Decision Aids (hosted by NHS Direct). A team from Imperial College's School of Public Health asks whether shared decision making involving patients with chronic musculoskeletal pain and various healthcare professionals improve patient care.

Take care

There's a week for everything, and from 14th to 20th November it's National Self Care Week. This year's campaign is being run in partnership with the Self Care Forum.
Meanwhile, here's an update of recently published work on self management:
The crucial role of information in supporting self care is examined in a review of how self management is applied in conditions like heart disease and kidney disease. Another review looks at evidence for patient self-management and access to healthcare services for ethnic minority groups living with diabetes. The British Journal of Cardiac Nursing offers a descriptive study of self management behaviours amongst patients with heart failure in Scotland. A qualititative study of primary care practices in the north of England assesses how self management issues are handled in general practice consultations where computer based disease management templates are also used.

Just checking

The idea of a postcode lottery often claims attention: a recent article in BMC Public Health considers how far this term can be applied to the outworkings of the Health Check as delivered in North West London. The study looked at how NHS Health Checks worked in 8 PCTs in the area, finding considerable variation, with substantial differences in funding levels and in how the programme was interpreted and implemented. Another study, this time from Stoke on Trent, looks at options for cost effective delivery of the Health Checks programme, comparing drop in clinics with booked appointments and considering the merits of targeting particular age groups.